Marcia Puñales1,2, Marilia Dornelles Bastos3,4, Ana Regina L Ramos5, Raquel Borges Pinto5, Eduardo A Ott6, Valentina Provenzi7, César Geremia1,2, Maria Antônia Soledade1, Ana Paula Schonardie1, Themis R da Silveira3,8, Balduino Tschiedel1. 1. Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil. 2. Pediatric Endocrinology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil. 3. Post-Graduation Program in Adolescent and Child Health, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. 4. Medical Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil. 5. Pediatric Gastroenterology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil. 6. Endoscopy Service, Nossa Senhora da Conceição Hospital (HNSC), Conceição Hospital Group (GHC), Porto Alegre, RS, Brazil. 7. Pathology Service, Nossa Senhora da Conceição Hospital (HNSC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil. 8. Santo Antônio Child Hospital, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.
Abstract
BACKGROUND: Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin-A anti-tissue transglutaminase antibodies (IgA-tTG) and CD in a large cohort of young T1DM patients. METHODS: Screening for CD was randomly conducted in 881 T1DM by IgA-tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy. RESULTS: The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA-tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7-131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CD patients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0-9.9 years). The modified Marsh-Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy-proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA-tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative-biopsies. CONCLUSION: Our results demonstrate the prevalence of 7.7% of IgA-tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high-risk individuals. Furthermore, the presence of GI manifestations and higher IgA-tTG titers strongly suggest the diagnosis of CD.
BACKGROUND: Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin-A anti-tissue transglutaminase antibodies (IgA-tTG) and CD in a large cohort of young T1DM patients. METHODS: Screening for CD was randomly conducted in 881 T1DM by IgA-tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy. RESULTS: The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA-tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7-131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CDpatients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0-9.9 years). The modified Marsh-Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy-proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA-tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative-biopsies. CONCLUSION: Our results demonstrate the prevalence of 7.7% of IgA-tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high-risk individuals. Furthermore, the presence of GI manifestations and higher IgA-tTG titers strongly suggest the diagnosis of CD.
Authors: Mara Cerqueiro Bybrant; Elin Udén; Filippa Frederiksen; Anna L Gustafsson; Carl-Göran Arvidsson; Anna-Lena Fureman; Gun Forsander; Helena Elding Larsson; Sten A Ivarsson; Marie Lindgren; Johnny Ludvigsson; Claude Marcus; Auste Pundziute Lyckå; Martina Persson; Ulf Samuelsson; Stefan Särnblad; Karin Åkesson; Eva Örtqvist; Annelie Carlsson Journal: Pediatr Diabetes Date: 2020-12-12 Impact factor: 4.866
Authors: Edip Unal; Meliha Demiral; Birsen Baysal; Mehmet Ağın; Elif Gökçe Devecioğlu; Hüseyin Demirbilek; Mehmet Nuri Özbek Journal: J Clin Res Pediatr Endocrinol Date: 2020-08-21